Morris Panner, Ambra Health Chief Executive Officer

Today, somewhere in America, a patient will receive a copy of their medical imaging on a CD. It’s hard to believe that this relic of the 90s still exists, let alone is in regular use at healthcare facilities. Many home computers and laptops no longer contain disc drives necessary for loading CDs, making the process for patients to view imaging inconvenient and cumbersome. And patients aren’t the only ones negatively impacted by the continued use of CDs.

The cost healthcare organizations incur from purchasing, burning, and couriering CDs is enormous. Hospitals can still spend as much as $15 per CD, according to 

 and some health systems spend upwards of $100,000 per year in courier costs alone.

The financial costs are only one part of the problem. If I challenged you to rummage through your old desk drawers, I bet you could find several, if not dozens, of old CDs destined for the landfill. This issue is exponential for radiology departments. It takes a CD roughly 

The 21st Century Cures Act and consumer demand has added momentum to the movement away from CDs and towards cloud-based imaging systems. This Earth Day, let’s commit to ditching the disc entirely. It’s better for patients, providers, and the planet.

Moving to Cloud-based Imaging is a Win-Win

In addition to reducing items destined to the landfill, moving to a cloud-based imaging system provides patients better access to imaging, saves facilities money, and improves care.

Adopting new technologies like these can go a long way toward meeting the growing 

 for access to personal health records. Cloud-based platforms enable medical facilities to create 

 that provide instant access to information and images.

The benefits of moving to a cloud-based imaging system for facilities are well documented – a reduction in administration time and lower burnout rates among staff, fewer processing errors, and less unnecessary redundant imaging exams to name a few.

For example, at Gunnison Valley in Colorado, the mountains bring in both a winter ski population and a summer hiking population, as well. However, with many tourists heading home at the end of each season, sending imaging via CD for follow-ups with home physicians quickly became a burdensome and expensive task. Particularly, during the winter, mailing a CD could take weeks if a snowstorm hit the region. Embracing the #DitchTheDisk movement, the marketing team was able to quickly spread the word regarding simplified electronic image-sharing. Today, imaging can be shared with patients and referring physicians in just a few seconds.

 that healthcare facilities spend more than 84 days per year on CD upload, burning, and patient data matching alone. Try 

 to determine just how much money your facility may be spending on CDs.

Every month, approximately 100,000 pounds of CDs become obsolete, 

 to the Environmental Protection Agency. Most are destined for the landfill or incinerator. One of the easiest ways to keep CDs out of the landfill is to reuse them, but due to sensitive personal health information, that’s not always an option for radiology departments.

Depending on their condition, CDs can be recycled for use in new products. Specialized recycling companies clean and grind the disc into raw polycarbonate plastic, resulting in white and clear powdery material that resembles snowflakes. The raw polycarbonate plastics can, then, be sold and melted down for a variety of new purposes, including in automotive parts, office equipment, and municipal electrical cable insulation. And 

The market for recycled CDs still remains nascent, according to the 

, which recently did an in-depth look on the life cycles of CDs. And when choosing to recycle, one must consider the carbon footprint tradeoffs for transporting the CD to a designated recycling center.

Prior to modifying your waste disposal practices, you’ll want to ensure any new actions meet HIPAA 

 of disposing media containing personal health information. Here are several options for recycling unused or clear CDs and other “techno-trash.”

 (founded on Earth Day in 1993 and headquartered in Sammamish, Wash.) is a fee-based service that offers a variety of options from “starter kit” to enterprise options for transporting “techno-trash” to their recycling processing plant.

 is another option. Operations are currently paused due to the pandemic, but you can request to be placed on a mailing list to be notified of its reopening.

Another option is to check with your local waste management company. Many municipal waste management companies have directions online on how and where to recycle or properly dispose of CDs and other “techno-trash.”

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Articles

Pivoting from CDs is a win for radiology, you just need to know how to do it.



Still Using CDs? Why You Should Ditch the Disk This Earth Day 

Whether you love or hate social media, there’s no denying its ubiquity. Over the past few years, radiologists have gone social and for good reason. We’ve seen social media’s utility play out even more during the pandemic -- providing valuable social connection and serving as a real-time communication tool for safety updates and information. Physicians today are using social media to find mentors, act as patient advocates, seek and share education, and build personal brands.

It should also be no surprise that physicians are taking an interest in social media as a younger generation settles comfortably into their careers. More than any generation before them, millennials search for recommendations regarding physicians and facilities online. An outdated website, lack of reviews, and difficulty accessing critical information could be a major turn-off.

But, it’s not just millennial radiologists using social media. Case in point? My favorite platform for engagement is Twitter, and I am certainly beyond the millennial generation. Radiology as a field has also recognized the importance of social media. With social platforms increasingly image-based, they are well suited to serve up bite-sized educational content for radiologists. On Instagram, “case of the day” challenges are becoming increasingly popular.

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-newsletter

Social media, however, is not without its downfalls, and regardless of which platform you’re using, physicians should be aware of best practices and potential problem areas to ensure healthy online engagement. Here are a few best practices for those looking to start or build their social presence.


Follow the rules: First and foremost, review your facility’s social media and marketing policies to ensure compliance. If you feel as though it is time for a change and an increased social presence, engage with senior leadership for a discussion on the topic. Facilities frequently have guidelines in place to protect patient health information.

Find your audience: Determine which platform is best suited to your social goals. Looking for educational content? You might consider Instagram. Want to connect with others professionally? Set up your LinkedIn. Looking to engage in real time conversation? Twitter will be a good place to start. It’s important to think through what you're looking to achieve with social for your personal or practice’s brands.

Connect with others: Social media is afterall, social. Once you set up your account It’s important to grow your follower base. You can do this by posting engaging content, following others and participating in forums and group discussions. Search for relevant hashtags to add to your content to make sure you’re getting noticed in relevant conversations.

Never share patient information: This is especially important for organizations posting educational content. Never share patient personal health information. Be cautious that no PHI can be seen in any photos.

Determine your personal and professional line: The lines today between our personal and professional lives are even more blurred but make sure you have a plan for how you want these words to collide in your online social spheres. Consider maintaining both private personal and professional accounts to keep conversations pertinent and appropriate.

Keep your profiles fresh and up-to-date. Make sure you have an updated photo, descriptor, and that you’re engaging on a regular basis. Now would be a good time to audit your existing profiles to make sure they’re up-to-date if you haven’t done so recently.

Social media is a fantastic way to network, share your work, and learn from others. Follow the guidelines above to stay safe while posting away!

Stepping Out of the Darkroom and Into Social Media 

A picture is worth a thousand words, yet many hospitals and health systems still rely on outdated, siloed, and on-premise technology for storing and transferring medical imaging. This outdated technology leads to most electronic health records (EHRs) missing a patient’s diagnostic imaging and only displaying text-based radiology reports. Imagine Facebook or Instagram with just words and no images; it’s a far less comprehensive picture of the individual.

The COVID-19 pandemic has ushered in a new sense of urgency for facilities to break down traditional barriers and allow seamless access to medical imaging data for trauma transfers, everyday telehealth appointments, second opinions, and more. A patient should never face a care delay due to the delayed arrival of medical imaging.

Teamwork between providers and coordination among various points from imaging centers, primary care physicians, and hospital surgical units are absolutely critical. U.S. hospital mergers and acquisitions have been a high rate for the past several years, and today’s patients may find themselves moving through several different locations rather than completing every test at one large hospital. Many physicians feel “trapped” and exhausted by onsite hardware and siloed systems. The administrative time currently spent shuffling around CDs, rekeying information on studies, and maintaining virtual private networks to exchange imaging and associated data is immensely frustrating and cost prohibitive.

 has shown that the average facility burns about 1,911 CDs per month. With each CD upload taking a few minutes (in a best-case scenario), that could waste hours each day. Administrators and clinicians are frustrated by this enormous waste of time with over 74 percent believing that eliminating CDs could increase job satisfaction.

Image enabling an EHR system takes away the frustration of dealing with CDs and logging into two systems and toggling between them. Instead, both patient records and imaging are all available directly from within the patient jacket. Single sign-on integration seamlessly authenticates users into the EHR for image viewing, with no need for multiple logins. Since imaging and data are integrated together within the patient jacket, patient health information also remains in sync.

Another key benefit of image-enabling the EHR is that it provides enterprise-wide viewing of a study simultaneously. In other words, multiple specialists can access and view an exam at the same time and from different places. For example, at UC San Diego Health, staff can upload studies off CDs within minutes with Ambra Health, and the study becomes available for network-wide viewing immediately. The workflow allows UC San Diego Health to match data from Epic to the CD and overrides the information on the disk. Ambra’s integration with Epic’s affiliated physician portal enables physicians to view imaging directly from the order record. It can also be configured for the physician to be able to view any prior imaging studies for the patient based on a Medical Record Number (MRN).

The current shift towards telehealth services has forced hospitals and health systems to evaluate their processes for sharing patient data. With the increase of remote visits and desire from patients to have access to their records, remote sharing has become a crucial part of medical records management. Patient and referring physician portals enable hospitals and health systems to automatically and easily share studies and reports with patients and referring physicians, making life easier and more efficient for patient and referring physician populations.

Image-enabling the EHR opens the doors to an image-enabled patient portal. The patient experience starts the moment they walk into your office and are greeted by front desk staff. Wasting time searching for an old CD, struggling to upload the images, or letting a patient know that their images are inaccessible for any reason are a less than ideal way to start any visit. Streamline processes by offering patients the ability to upload prior imaging from CDs directly to you ahead of an appointment. 

Or better yet, stay connected through the cloud to local imaging centers that frequently send to your office so that patient imaging appears directly in your EHR system leading to a seamless appointment. After the appointment is over, providing patients with a user friendly and easy-to-access patient portal is a great way to stay in touch and encourage patients to take control of their own health data and, in turn, their health as a whole.

Image-enabling the EHR can have long-term health benefits for patients. The U.S. Food & Drug Administration’s Center for Devices and Radiological Health (CDRH

Unnecessary Radiation Exposure from Medical Imaging

. The CDRH developed several key initiatives that keep in mind that imaging exams must do more good than harm. Among these was a movement to incorporate key quality assurance practices into both hospitals and imaging facilities.

Image enabling the EHR allows physicians easy access to patient imaging – reducing the number of duplicate test orders and the amount of radiation exposure. In addition, a cloud-based suite allows physicians to not only place the current order, but also search archived imaging for all previous medical imaging associated with that patient across their network.

As busy physicians spend their days suiting up in personal protective gear and face a steady stream of patients, the last thing they should need to worry about is logging into multiple systems to access critical information. It’s time for facilities to push towards greater interoperability and unified systems.

It is time for facilities to push for greater interoperability and unified systems. 

Why Image-Enabling the EHR Benefits Patients and Providers Alike

A small silver lining of this global pandemic may be the realization that we do not always need to take a full day off work to head to the doctor’s office. The concept of telehealth has existed for several years now but was rarely a reality. In fact, I cannot recall a single physician of mine that offered telehealth as an alternative to appointments prior to the COVID-19 pandemic.

Today, many physicians are more than willing to conduct telehealth visits for minor aches and pains, routine check-ins, an initial screening, or even a second opinion. Not only has the increase in telehealth been beneficial for busy patients (who are often managing both work and children at home) but also for physicians who find themselves in far less crowded offices.

, more than 79 percent of specialists surveyed said that their use of telemedicine has increased since the pandemic began. Many also said that they would continue to use virtual services in the future. The increased use of telemedicine was made possible by several key legislation changes. The U.S. Health and Human Services Office for Civil Rights announced that it will, “not impose penalties for non-compliance with the regulatory requirements under the HIPAA Rules against covered healthcare providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency." Additionally, Centers for Medicare and Medicaid Services 

expanded its Medicare telehealth coverage during the COVID-19 pandemic

 for telehealth services during March and April of 2020. 

Remote Reading? 4 Experts Weigh in on the Post-Pandemic Future of Teleradiology

Telehealth has been a long time coming. Physicians have sought creative ways to reduce the number of patients entering and exiting facilities, including imaging centers, for years, testing a number of different methods. For example, r

 followed patients in 2017-2018 and studied whether an electronic consultation between radiologists and referring physicians could lower unnecessary imaging exams. Positive care improvements were seen with the use of this program. Unnecessary imaging went down and in more than 55 percent of cases, imaging that was still recommended altered patient care plans for the better. 

Radiology as a specialty has always been at the 

 with teleradiology work being commonplace for over a decade. Radiologists are often able to work securely from home and offer tele-consults with patients who may have additional questions regarding findings. At New York University Langone, about 25 percent of radiologists read from home. Today, that number has 

However, both patients and physicians should not dismiss the need for in-person care when appropriate. For example, since the outbreak of COVID-19, there has been a 

 leading to poorer prognosis for patients. 

The post-COVID world will need to establish a critical balance between appropriate telehealth usage and in-person visits, imaging exams, and procedures. Could artificial intelligence play a role in determining usage? Advanced symptom-based algorithms may be one such future tool that aid in differentiating between the necessity for telehealth or in-person care. In addition, wearable technology may be another tool that appropriately flags the need for increased intervention.

Our world is forever changed but what is clear is that telemedicine is here to stay, and facilities should build their strategies in anticipation. Organizations should examine their needs as a whole and avoid building a piecemeal approach to their telehealth strategy. Facilities scrambled to put into place whatever program was needed for initial needs. But, for telehealth to succeed in the long term, a truly robust and comprehensive strategy will be needed. If budgetary constraints are an issue for your facility, consider choosing a platform that could scale up at a later time.

Training for the entire team ranging from administrative support to physicians, and even patients, is also a necessity for long-term program success. A comprehensive approach is one that touches on each part of the healthcare trajectory and takes the patient on the best path possible for an ideal outcome.

Changes from COVID-19 have created a healthcare environment where telehealth – an in particular teleradiology – will be a permanent fixture.


Is Telehealth Here to Stay?

Patients have never been more vested in their own health journey. With new coronavirus infections soaring again across much of the country, it makes sense that we are now hyper-vigilant about the state of our own health.

One need not look far for evidence of this shift in behavior. From new consumer-initiated services that bypass the traditional route of getting referred by one’s primary caregiver for additional testing to receiving results on-demand in a patient portal, patients are hopping into the driver’s seat. In a post-pandemic world are we going to see patients expecting more access to their health data on-demand? 

A healthcare system under transition has meant that more than ever the patient is at the center at every stage of their journey -- from physician, to radiology, to follow-up. But, for radiologists, this shift can pose a significant challenge, because their role has traditionally meant contact mostly with other doctors, with limited patient engagement.

However, radiologists are increasingly changing how they work in order to engage with patients more. With the growth of patient and physician portals, and increasingly activated patients, there are more opportunities for contact than ever.

Patient-centered healthcare initiatives have been underway to empower patients to take more responsibility for their healthcare for years, but the reality has rarely met the enthusiasm. In 2015, a 

study in Perspectives in Health Information Management

 found that approximately half of healthcare providers surveyed who offered patient portals reported that less than 5 percent of their patients actually used it. As of 2018, little had changed: 

 found that only 52 percent of patients were offered online access to their records of which 28 percent had actually viewed them. This level of usage is truly abysmal considering how important online and mobile services are to all aspects of our daily lives.

 are nudging institutions to adopt more tech-friendly practices to engage patients directly and share vital health information, but adoption has been slower than in other industries. This could be due to the fact that the healthcare industry has been slower to build healthcare technology at a consumer-grade or the reality that so many silos exist that it’s more burdensome for the patient to take charge than just let the system work as it always has. Interoperability and standardized data criteria for API developers are the key factors for ensuring effective technological innovation.

The pandemic has ushered in a new sense of urgency for patient-centered care. In the first half of 2020 alone, U.S. digital health companies raised a record-setting $5.4 billion in venture funding 

. This demonstrates there’s never been a greater need—or demand—for technology-enabled healthcare.

Many of the previous barriers to tech adoption rapidly dissolved out of necessity as doctors turned to video conferencing for consultations, labs launched more direct-to-consumer offerings, and patients equipped themselves with medical monitoring devices like pulse oximeters in their homes. It will be paramount that the healthcare industry and technologists alike prioritize consumer demand when considering innovation. With all the complexity in the healthcare system and a patient’s own needs, providing more information without context and within siloed applications may be counterproductive.

The next challenge will be ensuring that with all of this information going directly to the patient, they will continue to have sufficient access to a trusted medical partner to provide actionable advice. In the past, radiologists have broadly been “the doctor's doctor”. But, increasingly activated patients, who are looking to participate more in their care, are looking for access to their complete medical records— from test results to imaging results. While most patients want to receive results directly from their referring physicians, many also want to see their radiology reports and images, too.

Ultimately, patients are looking to receive results from more channels and get more data points. Comprehensive electronic health records, easily accessible by the patient, will be essential. 

As the desire to know more about individual medical records grows, easy accessibility for patients will be vital.

Will the Covid-19 Pandemic Accelerate Patient Access to Data?

Should I go to the doctor? This is a recurring question on the minds of those due for routine appointments, screenings, or maybe even a simple check-in. So far, the public has largely heeded warnings to delay routine screenings and move as many consultations as possible to a virtual setting. While these are all valuable behaviors to reduce the spread of COVID-19, there are certain exams that cannot be done virtually, many of which include routine imaging screenings.

Routine screenings for colon, breast, and cervical cancers have dropped between 

 compared to the previous three years, according to medical records software provider, Epic.

Just how important is routine imaging? A few years ago, the 

 by the American Cancer Society noted a 39-percent reduction in breast cancer deaths since the 1980s due to earlier detection and diagnosis. Screening with low-dose spiral computed tomography (LDCT) has also been shown to reduce lung cancer mortality by about 20 percent compared to standard chest X-ray among current or former heavy smokers ages 55-to-74. Researchers have also been studying the possibilities of other imaging exams for screenings of traditionally hard-to-treat cancers, such as pancreatic and ovarian cancers.

Over the last few years, recommendations have already become increasingly confusing with The U.S. Preventive Services Task Force (USPSTF) changing 

, including raising the suggested annual mammography age to 50 for women instead of the previously recommended 40. Their concern was that false positives led to unnecessary and often stressful biopsies for women. However, many physicians and radiologists strongly disagree with these recommendations. Over 

 of physicians still suggest that routine mammography screenings should begin at age 40.

So, if these imaging exams are so valuable, how long exactly can you wait for routine screenings? The information here is highly muddled. Currently, the American Cancer Society 

 that routine screenings should be skipped. They say a delay of one-to-two months is okay for those at average-to-low risk. However, those at high risk due to a family or personal history of cancer should discuss their case with their physician. Some screenings can even be done at home if needed, like colorectal screenings, using an at-home test. Non-imaging related exams like physician, well-woman, and annual skin cancer screening can often be conducted virtually initially and, then, a determination can be made on a date for an in-person visit.

Healthcare technology vendors can help retain imaging value while reducing volume by providing patients with enhanced access to past imaging and allowing them to share data with providers through patient portals, image-enabled EHR portals, and more. The ability for a patient to send and consult with a physician on prior imaging may allow both parties to make a more educated decision on the timing of future exams.

In some cases, certain risk factors might push a physician to encourage someone to stay at home and put off routine exams for longer. Patients should always consult with their own physician on their personal health history and weigh the pros and cons of routine imaging. However, as imaging centers increasingly take new precautions on the safety of their facilities and add new technology that could reduce in-person interaction where possible, healthy patients will likely be able to resume necessary and routine image screening.

With safety precautions in place, imaging centers can consider bringing in healthy patient for screenings.

Assessing Value Versus Risk for Routine Screenings

A lack of available COVID-19 testing in the United States has many asking the question, could we be using CT scans to rapidly diagnose patients instead? This question has attracted both attention and conflict.

 emerging from Wuhan showed that 97 percent of cases with a COVID-19 diagnosis had CT findings consistent with pneumonia and shared that, “CT imaging has high sensitivity for diagnosis of COVID-19.” However, a recent critical review in the 

 called for CT imaging to be used only in cases of complex pneumonia. Currently, the authors believe that we do not have enough data to support the use of CT scans for diagnosis and that using the machines can pose additional risks for healthcare workers on the frontlines or potentially expose healthy patients to the disease.

The authors shared, “These risks include: overuse of hospital resources, including the use of protective gear that is already limited in availability but is required to safely perform CT studies; clustering of affected and unaffected patients in imaging departments, thereby potentially increasing risks of disease transmission and exposure among staff performing the examinations; patients for other indications because of increased use of CT scanners to evaluate cases of suspected COVID-19.”

The American College of Radiology agrees and has set new 

 and guidelines around appropriate imaging techniques. These include that CT scans should not be used for diagnosis and used sparingly for patients who have pneumonia or other critical symptoms. The ACR believes that a normal CT may not mean that a patient does not have COVID-19 and vice versa. They also encourage the use of portable scanners when possible so that patients can be imaged directly in the ER or ICU rather than traveling to radiology.

Using portable scanners poses an additional challenge to facilities who now must ensure that they have a mechanism of transferring imaging from portable scanners directly into radiology PACS. While some facilities may already have cloud-based imaging workflows in place, others are still heavily tied down by siloed systems.

Radiology departments should remain prepared for an influx as new data is constantly emerging and confusion in hospital policies could lead to patients appearing through their doors looking for a diagnosis. Researchers from the University of Southern California outlined the disaster 

 that departments should take and said, “It is clear that the radiology department will need to be ready for the COVID-19 outbreak. Major factors that will affect radiology throughput are transportation, cleaning equipment, proper usage of personal protective equipment, and interpretation of radiologic examinations. Having an MCI plan in place for a viral outbreak will protect patients and staff and ultimately decrease virus transmission. The use of simulations will help identify throughput and logistical issues.”

Some imaging centers faced with lower volumes are even considering opening COVID-19 only imaging centers. As these centers open across the country, new data could emerge to support the benefits of imaging for testing purposes. Artificial intelligence may also enable more rapid imaging analysis going forward.

At UC San Diego Health, physicians are using AI tooling in a new 

 on imaging analysis powered by Amazon Web Services.

“We would not have had reason to treat that patient as a suspected COVID-19 case or test for it, if it weren’t for the AI,” said Christopher Longhurst, MD, chief information officer and associate  chief medical officer for UC San Diego Health. “While still investigational, the system is already affecting clinical management of patients.”

The use of imaging for COVID-19 diagnosis will continue to evolve and radiology departments must be prepared for a potential influx of patients, new safety protocols, and guidelines regarding appropriate measures, dosage, and productive usage.

Departments and practices must be prepared for the impending influx of imaging.

The Continuing Evolution of CT Use During COVID-19

Discussing the importance of virtual care and telehealth services, including teleradiology, is nothing new. Previously, many of these conversations fell into the bucket of “want to have” rather than “need to have,” especially, for those of us fortunate to have top-tier medical facilities nearby. Today, as COVID-19 changes the way many of us think about daily life, the ability to access a medical professional or service virtually suddenly seems quite urgent. Traditional concepts of geography (which often affected patients in rural areas the most) may now apply to as short of a distance as one subway ride.

A patient that is a regular visitor to their physician’s office or their local hospital is often a patient who is also most at risk of developing a serious COVID-19 infection. Physicians should consider utilizing telehealth for these patients to reduce their time spent in public. While there is a stereotype that older patients may not be as technologically savvy, 

 have shown that Boomers are, in fact, very much in favor of digital health and are interested in using technology to facilitate reminders, after-hours visits, daily support, classes, and appointment follow-ups.

On Monday of this week, the Trump administration announced the expansion of telehealth services for Medicare beneficiaries. This includes paying doctors and facilities for telehealth services in replacement of traditional hospital visits, medical practice visits, and even mental health care in some cases.

“This action is a part of our broader effort to ensure that government requirements, [and] rules and regulations don’t get in the way of patient care during an emergency,” said Seema Verma in a press conference at the White House on Tuesday. “These services can be provided in a variety of settings, including nursing homes, hospital outpatient departments, and more.”

Traditionally, HIPAA has acted as a complex barrier when it came to telehealth. However, the new guidelines have broken down many of these same barriers, allowing greater flexibility for physicians to use their own phones and conduct virtual “check-ins” of patients with high-risk conditions. Guidelines still urge that practitioners avoid communications on social media applications to reduce privacy concerns.

Many facilities have already had success with telehealth programs. At WakeMed Health and Hospitals in North Carolina, Valerie Barlow, Vice President of Clinical and Support Services said, “61 percent of patients who used WakeMed Virtual Urgent Care and completed the survey would have gone to an urgent care facility had they not had access to this telemedicine option, (and) 14 percent of patients who used virtual care and completed the survey would have gone to an emergency room had they not had access to the service.”

Virtual services provide a solution to reducing physician burnout and keeping only the most at-risk patients in hospitals.

Virtual solutions can also offer physicians a method of educational collaboration. In the UK, The British Society of Thoracic Imaging (BSTI), in conjunction with Cimar UK’s Imaging Cloud Technology (

 to upload and refer imaging of patients with either confirmed or suspected COVID-19. All cases are automatically anonymized by CIMAR at the point of upload. Access is public, and the platform already has over 5,000 views despite just being live for a few days.

Access to healthcare needs to be virtual more than ever. Facilities and providers must be open to accepting creative solutions, and technology vendors should work together to enable these new and exciting workflows. Together, we can all work to offset the burden on our healthcare system during this challenging time.

Remote services and providers can help control the spread of infection.

COVID-19 Spotlights Need for Virtual Services, Including Teleradiology

Medical imaging is more spread out than ever before across a geographically distributed and diverse referral and patient community. For example, in New York City, a large health system like Weill Cornell has a wide range of physicians, some who are affiliated with the institution and some who aren’t. They’re also one of the medical schools and practices that are part of the New York Presbyterian Healthcare Organization and have a sister institution with Columbia Presbyterian. The net result is patients frequently coming and going and a real need to streamline image workflows across a disparate network.

In an era where efficiency is everything, improved image exchange can ensure that imaging gets to the right person, whether physician, radiologist, or patient faster. It’s also a critical step in reducing duplicative imaging. Pairing an image exchange strategy with the cloud enables imaging to be finally freed from the confines of on-premise silos, enabling it to be connected to referring physician and patient portals, downloaded or uploaded with just a hyperlink, or even tightly integrated with EMR, EHR, and CDS systems, all to improve accessibility and clinical decisions.

When we talk about imaging, we need to discuss BOTH imaging in and imaging out - how is imaging entering a facility, exiting, and returning to various key stakeholders.

An effective image management strategy must take into account each unique stakeholder. First, you have radiologists who find themselves in the middle of an increasingly image-centric healthcare model. They’re looking for strong follow-up from referring physicians, increased involvement in patient care, and clear prioritization of relevant studies, especially when pressed with increasing image volume. In return, referring physicians measure value in radiology in the quality, speed, and efficiency of the radiology services they request, like the turnaround times on orders. Then, of course, we have our patients, who are acting as consumers more than ever before. Patients gauge how smoothly both imaging procedures are scheduled and managed as part of their treatment plan and how fast they get radiologic results from their physician. In the meantime, IT staff look to engage with radiology by ensuring that imaging is easily accessible yet compliant with privacy and data security policies.

The first step in improving any image management workflow is the elimination of CDs. Data we have gathered at Ambra Health has shown that healthcare facilities are wasting over 84 days per year on CD upload, burning, and patient data matching. Relying on a medium-based transfer method like CDs also leads to increased spending for hospitals, sometimes well over $100,000 a year on courier costs alone. A recent study published in the 

highlighted the frustrations of physicians looking for access to patient imaging; they referred to the process as both time-consuming and cumbersome.

When it comes to inbound imaging, facilities need a strategy for accepting imaging electronically, uploading CDs as needed, and perhaps, most importantly, rapidly matching patient data. At one leading facility, the film library struggled to keep-up with the demands of CD burning, ingestion, and matching of patient data often leading to back-logs, missed revenue opportunities, and most importantly, delays in clinical care. After switching to a cloud-based solution, image intake was sped up to just minutes including accurately matching imaging with patients within their EHR system.

Receiving imaging isn’t the only challenge; sending it out can prove just as difficult. We’ve seen many facilities move to using cloud image sharing and gateways to route imaging across regional networks. Imaging informatics doesn’t just cover imaging acquisition, it also includes getting the information back to the referring network or directly to the patient. Report turnaround time is perhaps one of the least well-analyzed areas of radiology, yet it is one of areas that is ripest for improvement and the most measurable. Keep in mind that forcing your referring physicians to sign up to an image sharing service, change their current technology or workflows, or requiring them to install or pay for software puts barriers between you growing your referrals.

Opening the doors to rapid cloud-based image exchange can provide your facility with a wealth of opportunities, ranging from revenue generating programs like second opinion portals, to AI and machine learning and workflow improvements, and even opportunities for new research and innovation. Consider your entire network and each unique workflow when implementing a solution that can provide unified and interoperable image management.

Embracing cloud-based image exchange can open several beneficial doors for your practice.

Imaging In and Imaging Out

Will the 2020s be the roaring twenties of healthcare? There is much that remains to be seen as many questions loom over the real efficiency level of artificial intelligence (AI) tools, patient control over data and its usage, and interoperability across vendors.

1) AI-Powered Tools Must Create More Efficient Workflows

It seems like a minute can’t go by without hearing of another AI tool that could help physicians make clinical decisions faster. This is an exciting space as tools have been shown to accurately identify lung nodules and breast tumors much faster than the human eye. Tools like this could greatly speed up the daily workflow of a busy radiologist. However, many tools still need training; they rely on feedback from the physician on whether they are correct or not. The hope is that over time the training of the algorithm will produce a far more accurate real-time decision. However, training takes increased time for the user of the product.

Additionally, there may be a disconnect between the creators of the application and the end users whether it’s physicians, nurses, technologists, etc. Will users be willing to devote the necessary time to AI tool improvements? This remains to be seen in 2020.

2) Ensuring Patient Consent and Understanding of Data Use

We know that patient consent is important when it comes to any procedure, treatment, and overall care. However, the concept of patient consent is evolving considerably in today’s era of big data.

HIPAA works to protect patient data from illegal usage and makes clear that patients own their healthcare data. Things get complicated once that same data has been completely anonymized; it is often then free for hospitals to use and sometimes even sell. As Adam Tanner, a fellow at Harvard’s Institute for Quantitative Social Science, shares in his book, Our Bodies, Our Data: How Companies Make Billions Selling Our Medical Records, many patients don’t realize that their data are being sold.

This may mean that facilities will need to overhaul traditional consent forms and explain to patients in jargon-free language how their data could potentially be used. As hospital and radiology practice mergers continue to occur, facilities must also update patients on the applicable policies of new institutions.

Patients should also be offered access to a patient portal where they can act as the owners of their medical data and images and use them as they please, including seeking second opinions.

3) Educational Societies Pushing Towards Interoperability

Vendors don’t always like to share but that may change with major groups pushing towards increased interoperability. The Radiological Society of North America (RSNA), Carequality, and the Sequoia Project, have developed an Imaging Data Exchange Implementation Guide Supplement to improve the technical standards that support the exchange of medical images.

The goal of the project is to eliminate CDs, which frequently cause serious care delays. Imaging on CDs can take days to arrive and, in the worst-case scenarios, cause a patient to have repeat imaging. Ambra Health, Life Image, and Philips Healthcare are three early vendors that have adapted to the Carequality Imaging Data Exchange Implementation program.

We hope that in 2020 vendors will work together to improve overall patient care and share imaging data more freely.

Ambra Health's CEO offers insight into what 2020 -- and beyond -- could bring in radiology.